Medicare Advantage - ESSENTIA HEALTH GROUP

Medicare Advantage Plans offer a few key differences that distinguish them from Parts A and B of the Original Medicarex Trusted SourceMedicare.gov (N/A)The official U.S. government website for Medicare, providing information about plans, coverage, costs, claims, resources, and more to the public.

Government Authority Go to source system managed by the federal government. While Part A pays for inpatient care at a hospital and Part B covers services and supplies used to treat or prevent medical conditions, Medicare Advantage Plans come with a few added benefits.

Plans are required to offer the same level of care as Original Medicare and may include additional health care benefits such as prescription drug coverage, routine hearing, vision, and dental exams, and fitness club memberships.

Designed to be an all-in-one solution, Medicare Advantage Plans are offered by Medicare-approved private insurance companies. There are several types of Medicare Advantage Plans available, depending on your insurance provider and location. Learn the differences between these plans and how they affect your coverage so that you can make the right choice for your medical situation.

What Medicare Advantage Plans cover

Medicare Advantage Plan Benefits

Hospital and skilled nursing facility inpatient careHome health carePrescription drug coverage (if included in your plan)Medically necessary outpatient services, such as:

Doctor’s visits
Ambulance services
Emergency and urgent care
Durable medical equipment (DME)
Mental health care
Prescription drugs that you cannot self-administer
X-rays
Laboratory tests

Preventive services, such as:

Vaccinations
Cancer screenings
Diabetes screenings
Depression screenings

Additional benefits (depending on your plan), such as:

Routine vision exams with allowance for glasses
Routine dental exams
Hearing exams with allowance for hearing aids
Fitness and wellness programs and discounts
Transportation to medically necessary care
Over-the-counter (OTC) drugs

Types of Medicare Advantage Plans

There are four types of plans available for Medicare Advantage program: Health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service (PFFS), and special needs plan (SNP). Each offers a different level of flexibility in your network of care providers and varies in price. All Medicare Advantage Plans provide the same coverage as Original Medicare, but additional benefits may come with an increased premium.

HMOs

HMOs typically require that you receive all services from in network providers:

You must have a primary care physician (PCP), referrals for specialists, and prior authorizations for treatments and some prescriptions.
Drug coverage usually is included. You aren’t able to purchase standalone drug coverage.
Lower costs if you stay in network.

PPOs

PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.

You don’t need to choose a primary care doctor or referrals for specialists.
Drug coverage is usually included.
You aren’t able to purchase stand-alone drug coverage.
Higher premium and out-of-network costs.

PFFS Plans

PFFS plans don’t require a primary care physician or referrals for specialists:

You can go to any Medicare-approved health care provider or facility that accepts the plan’s payment terms and agrees to treat you.
May include drug coverage, or you can purchase a standalone drug plan.
Higher cost if you choose a provider that doesn’t agree to the plan’s terms.

SNPs

SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:

You need a PCP and referrals to specialists.
Drug coverage is always included.
If you’re eligible, you can join an SNP at any time.